Life is Healthy

Transvestite sex workers waiting for customers in Yogyakarta. Activists are concerned that discrimination against high-risk groups is fueling a growing HIV/AIDS rate. (AFP Photo)

Ingrained social discrimination against gays and transsexuals, at times by the very health care workers charged with helping them, is a major contributor to the spread of HIV/AIDS among these groups in Indonesia, activists said on Tuesday.

“The discrimination they experience, including from health officials, makes them reluctant to seek treatment to curb the spread of the virus,” said Nafsiah Mboi, secretary general of the National AIDS Prevention Commission.

Nafsiah told the Jakarta Globe that his body’s 2007 study, the Integrated Bio Behavioral Survey, found that HIV/AIDS rates among transsexuals were a staggering 35 percent, compared to 10 percent among heterosexuals.

In Indonesia, gay and bisexual men are particularly at risk from contracting the disease as they are more likely to have sexual encounters among the other groups.

“They have sex with transsexuals as well as with other gay and bisexual men,” Nafsiah said.

A UN-backed report, which was previewed on Monday, suggests the situation was mirrored throughout Asia, where gays have registered alarming levels of HIV/AIDS infection rates and are often denied access to services and care due to punitive laws that drive them underground.

According to the report, produced in part by the United Nations Development Program, “up to 30 percent of new Asian HIV infections will be gay men, unless prevention is intensified.”

The report said laws and police practices, such as Shariah law in Aceh and laws on public disturbance and prostitution, drove gay and bisexual men away from the HIV prevention services and care programs established to help them. But a more worrying finding was the report’s assertion that more than 90 percent of gay and bisexual men in Asia do not have access to prevention and care in the first place.

Rohana Manggala, head of the Jakarta AIDS Commission, pointed to the need for increased public awareness to stamp out discrimination against gays and transsexuals in Indonesian society.

“There was a recent incident where members of a hard-line Islamic group broke up an education workshop for transgender and gay groups in Depok,” she said.

Her organization strives to train community health center officials to end the discrimination, but its message often goes unheard. And that is bad news for a country grappling with a growing HIV/AIDS problem, and where 425 people die every year in the capital alone from complications caused by the virus.

Yulianus Rettoblaut, from the Indonesian Transsexuals Communication Forum, told the Globe that the problem within her community was even more pronounced. She said the country’s transsexuals were being “pushed by their environment” toward a greater risk of contracting HIV.

“Everything that happens to us is a result of discrimination, because people see us as being different from the outset,” Yulianus said.

She said that most transgender Indonesians turn to sex work as a last resort and after being denied jobs within mainstream society.

“It’s hard for us to get a job in either the formal or informal sectors, but we need to live and put food on the table,” Yulianus said. “So sex work is the only option left.”

Compounding the problem is a reluctance on the part of many clients to use protection.

“We bring condoms and ask the clients to use them, but they refuse, so what can we do?” she said.

“If, however, we were treated as regular people and not denied jobs, I believe the HIV prevalence among our group wouldn’t be so high,” she added.

According to figures from the UN, there were an estimated 193,000 people countrywide living with HIV/AIDS in 2007. But that figure surged to 270,000 just one year later.

The Health Ministry reported 47,000 cases in Jakarta alone as of October 2008, while in Papua and West Papua, fears are mounting over what some have called “epidemic-level” infection rates.

Other high-risk groups include intravenous drug users and commercial sex workers.

Rohana said her organization was trying to raise public awareness of a 2008 bylaw on HIV/AIDS prevention, but had a bone to pick with the terminology adopted by the legislators who wrote the bill.

In one archaic phrasing, “sexually transmitted disease protection tool” is used in place of the word “condom.”

“They should just have called it a ‘condom,’ as that’s something that we can campaign on more effectively,” she said.

Rohana is now lobbying the Jakarta administration to revise the bylaw to include the word “condom.”

“The problem is condoms conjure up notions of prostitution, which is why the administration glossed it over,” Rohana said.